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My Personal Health: Cyclical Extreme Fatigue Explained: Diagnosis of Hashimoto’s Thyroiditis and Epstein Barr Virus (EBV)

Update: see things that I think are helping.

A negative test result means that SARS-CoV-2 specific antibodies were not detected in the specimen above the limit of detection... This test was performed using Diasorin Liaison XL methodology which is designed to detect IgG antibodies to the spike protein of SARS-CoV-2. COVID-19 lab tests are currently reviewed by the FDA under Emergency Use Authorization (EUA).

Thyroid Perox AutoAb = 233 IU/ml (cutoff of 60)

It’s not welcome news, but I finally have insight into the debilitating cyclical fatigue cycles I’ve been having—the last 6 weeks have been particularly unproductive and frustrating, but it was really severe for a week in June and also back in mid-April when I thought it might be COVID-19—apparently not.

The two things might not be coincidental.

The role of Epstein-Barr virus infection in the development of autoimmune thyroid diseases

Based on the present studies, EBV infection can cause autoimmune diseases, such as systemic lupus erythematosus (SLE), multiple sclerosis (MS), rheumatoid arthritis (RA), Sjögren’s syndrome, and autoimmune hepatitis. The EBV has also been reported in patients with autoimmune thyroid disorders. Although EBV is not the only agent responsible for the development of autoimmune thyroid diseases, it can be considered a contributory factor.

NCBI: Epstein Barr Virus may have a link to inducing autoimmune thyroid disorders like Hashimoto’s disease.

We assume that high prevalence of EBV infection in cases of Hashimoto's and Graves' diseases imply a potential aetiological role of EBV in autoimmune thyroiditis. The initiation of autoimmune thyroiditis could start with EBV latency type III infection of follicular epithelium characterised by LMP1 expression involving the production of inflammatory mediators leading to recruitment of lymphocytes.

Tests and prognosis

With a thyroid peroxidase antibody test (“Thyroid Perox AutoAb”) result of 233 IU/ml vs a cutoff of 60, my doctor tells me that confirms a diagnosis of Hashimoto’s Thyroiditis. Which one of my daughters has suffered from for years, long a source of distress for me as a parent (no parent likes seeing a child suffer). So far, my T3 and T4 hormones are at normal levels.

Also a positive antibody test (“EBVNA Ab,IgG Qual”) for recent Epstein Barr Virus (which causes mononucleosis, but not in my case according to a normal WBC count), which is odd since I literally had no physical contact with anyone for four months from March through June. Since apparently EBV can lie dormant and erupt again, I now wonder if my hard core ultra endurance efforts periodically triggered it—that would explain fatigue cycles over the years that I could not otherwise explain.

But nothing compares to 5.5 months of steady fatigue following my possible COVID-19 infection in April 2020. I suspect that it’s all related.

Besides fatigue, some joint paint and aches mean I’ll have to do a lot of resting/sleeping, which is a bit tough when hiking in the mountains soon for my photography work. Maybe I will take a lightweight sleeping pad, and take a solid nap mid-day out there somewhere, plus give up days when I don’t feel strong. I am hoping that I can resume double centuries next spring.

Update October 17 2020: I was able to ride my baseline ride for 4 days at a greatly reduced effort of ~150 to ~180 watts (versus normal of 200 watts), but by the 4th day I was toast and then hosed for the next week or so.

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